Asking For Some Prayers-Updated At The Bottom

[Calamity Kris]

I've hit a bit of a rough patch as of late and could use a little "knee mail", if you are so inclined.  I've been battling some health issues while trying to get scheduled for my knee replacement.  I received some not good lab results on Friday afternoon, so I left my GP a message wanting to discuss a path forward.  Saturday morning, I received a text message stating my GP was leaving the practice and I needed to find another one.  Later that day, I received an email from the practice telling me I owed over $700.00 for two office visits.  

 

Please understand, I'm not looking for a pity party.  I just need some guidance on how to get out of all this.  

 

Uno calls me the strong one.  I just don't feel like it right now.

 

Thanks,

CK

Edited July 28 by Calamity Kris

[Buckshot Bear]

So sorry to read this Kris, I think I can speak for all here that we are here for you. 

I'm sorry you're going through this rough trot. 

[Eyesa Horg]

😞 Kris, so sorry to hear this. Our best thoughts and prayers are with you. You can do this. Stay strong and keep your chin up. 🙏🤞

Eyesa & Ellie 

 

[Rye Miles #13621]

I assume you have health insurance, why is the bill from your former doctor so high? $700 for two visits? That’s outrageous! 

[Sheriff Dill]

Prayers up for you finding a new practitioner to help you navigate the health battles you have been faced with. Strength and guidance to continue to walk strongly and confidently forward one step at a time as you navigate what you have been dealt. 
 

Side note I would call the offices during business hours. I know most of our offices around here are closed on weekends especially bookkeeping. 
 

SD

[Forty Rod SASS 3935]

Hang in there.  Prayers are on the way and you're tough enough to get through this.

 

Tom

 

BTW, if this guy is leaving the practice why do you owe him anything?  If I were you I'd challenge that.....and the amount.

Edited July 27 by Forty Rod SASS 3935

[The Original Lumpy Gritz]

Stay the course! 🤠

That bill sounds like BS, have it reviewed! 🤯

[Shotgun-Gibbs]

Prayers from Ohio! Things have a way of working out.

[Blackwater 53393]

Definitely demand an itemized statement with detailed explanations of every item!  Unless some procedure was performed, this sounds really fishy!

 

Insurance should cover most tests or scans with only a deductible and if you’ve been receiving treatments of some kind, you may have already met any requirements for maximum personal expenses.

 

Search carefully and thoroughly to find a new physician! Ask friends and colleagues who have had similar health issues about their doctors.

 

And by all means, please accept our prayers and best wishes for your complete and speedy recovery.

[Sedalia Dave]

Thought and Prayers on the way.

 

 

[Duffield, SASS #23454]

My prayers are with you. 

To find a GP ask nurses at your hospital who they would take their mother to .

[Eyesa Horg]

I've been trying for several years to get a new PCP. So far no luck! My insurance only calls Dartmouth Health my in network provider. So if I want a new one I could end up driving a minimum of an hour+ if one has an opening for a new patient. My current Doctor is only 20 minutes! So I'm stuck for now!!

Good Luck Kris, I hope you are able to resolve this setback.

[Calamity Kris]

5 hours ago, Rye Miles #13621 said:

I assume you have health insurance, why is the bill from your former doctor so high? $700 for two visits? That’s outrageous! 

 

3 hours ago, Forty Rod SASS 3935 said:

BTW, if this guy is leaving the practice why do you owe him anything?  If I were you I'd challenge that.....and the amount.

 

3 hours ago, The Original Lumpy Gritz said:

Stay the course! 🤠

That bill sounds like BS, have it reviewed! 🤯

 

3 hours ago, Blackwater 53393 said:

Definitely demand an itemized statement with detailed explanations of every item!  Unless some procedure was performed, this sounds really fishy!

 

Insurance should cover most tests or scans with only a deductible and if you’ve been receiving treatments of some kind, you may have already met any requirements for maximum personal expenses.

 

Thank you for the advice on the bill.  It is my PLAN to leave work early so I can go home and start making some calls.  The first bill was for a visit in April and it was the expensive one.  The only note they gave me was that all the charges were denied by insurance.   The fishy part was when I chatted with the NP I was seeing, we discussed ways she could code my visit so the insurance WOULD cover it.  I have a feeling she had a falling out with the primary physician in the practice and is being asked to leave.  I have learned that a practice can tell you they take your insurance but if they don't code the submittal to the insurance company in a certain way, the insurance company won't accept the charges and you're on the hook for the whole amount.  We'll see how this afternoon goes.

 

Thanks for your prayers and concerns.

 

 

[Eyesa Horg]

It took me several years to get my annual exam covered. Finally found out they were coding me as ambulatory, meaning I "walked into the office", the billing folks halfway across the country thought it meant by ambulance which is not covered!!!

[DeaconKC]

Praying here for you.

[Rip Snorter]

Contact the Insurance Company and challenge the refusal.  Sometimes it is just a question of how things are described. Wishing you all the best!

[Forty Rod SASS 3935]

Way back in 1996 my wife got a wildly high bill for a treatment and challenged it.  She worked for a marvelous attorney who coached her on the letter she wrote.  He advised her to tell them that she would NOT pay anything until the matter was resolved, because if she did they could claim she had agreed to it, then backed out.

 

Took four months but they finally dropped the whole matter.  She checked all of her credits and they never touched her rating, either.

[Cold Lake Kid, SASS # 51474]

Prayers for your health, new knees, a successful battle with the insurance bureaucracy and you medical care team..

 

[Rye Miles #13621]

Hope it all works out for you, surgery and the  insurance headache. 🙏🏻🙏🏻🙏🏻

[watab kid]

my prayers are with you , i enjoy your posts here , i want you here in the future , not privy to the details so cant offer a lot of insight , please know life is good , things will get better 

[Linn Keller, SASS 27332, BOLD 103]

Standing up on my knees for your knees (along with rest of self!) -- free advice omitted as you've already gotten more and better than I could provide!

[Subdeacon Joe]

Asking Sts. Panteleimon and Cosmas & Damian for their prayers for you. 

 

As others have said,  it's probably something in the codes used for the charges.

[Will Kane]

[Calamity Kris]

I finally had a conversation with my practitioner. 

 

The building she was in is adjacent to a medical practice that specializes in vascular issues.  Well, the doctors that own that practice and the two buildings decided they wanted to use the second building for x-rays, ultrasounds etc. so they shut down the primary care office.  Both practitioners in that building, as well as the staff have to find new jobs.  My practitioner did recommend someone to me.  She sends her mother to this person so I will take that as a high recommendation. It's now on me to get an appointment with them and get the records transferred over before the office shuts down and the records go into storage.  Both practitioners had to sign non-compete agreements when they signed on with this group so they can't go to another practice, nor open their own.  My practitioner lives in another county so she will be working at a hospital in that county.  

 

She also recommended a couple of specialists to me.  I spent the better part of this afternoon on the phone trying to fine an office of these specialists that is taking new patients.  So far, I'm batting zero.  Will get back on the phone tomorrow afternoon.

 

P.S.  I still have not heard from the billing office of the practice.  I will keep trying to pester them until I get to the bottom of this.

 

Thanks for the payers and well wishes.  I appreciate it.

Edited July 28 by Calamity Kris

[Eyesa Horg]

Thanks for the update Kris. Prayers and good thoughts to continue 🙏🤞.

[Chantry]

On 7/27/2026 at 11:56 AM, Calamity Kris said:

The first bill was for a visit in April and it was the expensive one.  The only note they gave me was that all the charges were denied by insurance.   The fishy part was when I chatted with the NP I was seeing, we discussed ways she could code my visit so the insurance WOULD cover it.  if they don't code the submittal to the insurance company in a certain way, the insurance company won't accept the charges and you're on the hook for the whole amount. 

 

 

 

I work in the health insurance industry.  As long as I don't know the name of your insurance company I'll help where I can.  (The company has treated me pretty well all these years).  Feel free to PM me if there are things you would rather not go over in the forum itself.

 

1.  Did they tell you upfront that the services were not covered? And yes coding can determine coverage under the benefits you get from your insurer. As an example, if you already had your annual wellness visit, a second one, usually within in a year depending on your benefits, it will be denied as non-covered.  Other general reasons for non-covered is cosmetic, unproven treatment or a pre-authorization or referral was required for what they were doing.  If you went in about a potential problem they should have used the correct diagnosis. indicting this was a problem visit, not a routine exam.  In GENERAL routine visits have a diagnosis starting with a V.  There are plenty of places online to look up diagnosis codes (ICD-10) and procedure codes (CPT codes).

 

2. Insist that they submit the bill to your insurance or get an itemized HCFA 1500 (standard bill for physicians) and submit it yourself.  You'll need the denial if it becomes necessary to escalate this problem. If your health insurance is through your employer, the employer MAY intercede on your behalf.  Note: the insurance company/ customer service cannot tell the provider how to bill or otherwise coach the provider on how to get the claim paid.

 

3. At the state level, there should be a department of insurance, whatever it might be called, who may also be of assistance.

 

On edit:  I have no medical training or coding/billing training, but over the past 25+ I've seen a lot of HCFA 1500 and UB04 (standard facility billing form) and MAY be able to help determine why they say it is non-covered.

 

Edited July 28 by Chantry